Interim authority notice under the Licensing Act 2003- Declaration of
Entitlement to work in the United Kingdom
I/We
(Insert name of applicant)
Having given an interim authority notice under section 47 for the premises
(Insert name of premises)
Hereby confirm the following date of birth and nationality for each applicant:
Individual Applicant named under (A)
Name
Date of Birth
Nationality
Individual Applicant named under (B)
Name
Date of Birth
Nationality
IT IS AN OFFENCE, UNDER SECTION 158 OF THE LICENSING ACT 2003, TO MAKE A
FALSE STATEMENT IN OR IN CONNECTION WITH THIS APPLICATION. THOSE WHO
MAKE A FALSE STATEMENT MAY BE LIABLE ON SUMMARY CONVICTION TO A FINE
OF ANY AMOUNT.
IT IS AN OFFENCE UNDER SECTION 24B OF THE IMMIGRATION ACT 1971 FOR A
PERSON TO WORK WHEN THEY KNOW, OR HAVE REASONABLE CAUSE TO BELIEVE,
THAT THEY ARE DISQUALIFIED FROM DOING SO BY REASON OF THEIR
IMMIGRATION STATUS. THOSE WHO EMPLOY AN ADULT WITHOUT LEAVE OR WHO IS
SUBJECT TO CONDITIONS AS TO EMPLOYMENT WILL BE LIABLE TO A CIVIL
PENALTY UNDER SECTION 15 OF THE IMMIGRATION, ASYLUM AND NATIONALITY
ACT 2006 AND, PURSUANT TO SECTION 21 OF THE SAME ACT, WILL BE COMMITTING
AN OFFENCE WHERE THEY DO SO IN THE KNOWLEDGE, OR WITH REASONABLE
CAUSE TO BELIEVE, THAT THE EMPLOYEE IS DISQUALIFIED.
I understand I am not entitled to be issued with a licence if I do not have the entitlement to live
and work in the UK (or if I am subject to a condition preventing me from doing work relating to
the carrying on of a licensable activity) and that my licence will become invalid if I cease to be
entitled to live and work in the UK
Part 4 – Signatures
Signature of applicant or applicant’s solicitor or other duly authorised agent. If signing
on behalf of the applicant please state in what capacity.
Signature
…………………………………………………………………………………………………
Date
…………………………………………………………………………………………………
Capacity
…………………………………………………………………………………………………
For joint applicants signature of second applicant, second applicant’s solicitor or other
authorised agent. If signing on behalf of the applicant please state in what capacity.
Signature
…………………………………………………………………………………………………
Date
…………………………………………………………………………………………………
Capacity
…………………………………………………………………………………………………